Category Archives: Medical technology
Human Capital News Roundup: The cost of disposable diapers, toxins in fish, fast food calories, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
WNYC in New York City broadcast an interview with RWJF Community Health Leader Joanne Goldblum about families reusing disposable diapers due to economic hardship. Goldblum, who is founder and executive director of the National Diaper Bank Network, conducted a study that shows how the practice leads to a range of problems for families living in poverty.
When it comes to digital health and new ways to deliver care, the focus should be on the consumer and improving outcomes, not on the technology, according to experts at a recent Connected Health Symposium in Boston, Massachusetts. Mobile Health News reports that Propeller Health (formerly Asthmapolis) CEO David Van Sickle, PhD, MA, an RWJF Health & Society Scholars alumnus, pressed for greater emphasis on outcomes. Read more about Van Sickle’s work here and here.
An American Thoracic Society panel of experts, including RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) grantee Richard Mularski, MD, is calling for better care for those who suffer severe shortness of breath due to advanced lung and heart disease. The Annals of the American Thoracic Society reports that the panel recommends patients and providers develop individualized actions plans to keep episodes from becoming emergencies, Medical Xpress reports.
Ode to My Favorite Gadget – This One Saves 99,000 Lives Per Year in the U.S. Can Your iPhone Do That?
Timothy Landers, RN, CNP, PhD is a 2012-2015 Robert Wood Johnson Foundation Nurse Faculty Scholar and an assistant professor at The Ohio State University.
A piece of technology that has transformed modern health care—and our careers—is the underappreciated hand sanitizer dispenser.
Nearly every field of nursing and medicine depends on advances in the prevention and treatment of infection. For example, it is now possible to perform extended surgeries on the brain or heart while controlling the risk of later death from infection. Combined with infection prevention activities, it is now possible to give immune-suppressing drugs to cancer patients who would otherwise certainly die of an infection at some point in their disease process. One hundred years ago, patients with trauma often died of infectious complications several days after the acute injury.
Advances in every field of medicine depend on good infection control. And good infection control depends on good hand hygiene. And good hand hygiene depends on the hand sanitizer dispenser.
Ann O’Brien, MSN, RN, is national director of clinical informatics for Kaiser Permanente - National Patient Care Services & KP Information Technology. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2011-2014).
I had the honor of hearing Donald Berwick, MD, present last week at the American Hospital Association Leadership Forum in San Diego. In fact, I registered for the conference to hear his keynote address. He brings the unique perspective of both of his previous roles: president and CEO of the Institute of Healthcare Improvement (IHI) and, most recently, director of the Centers for Medicare and Medicaid Services.
But more importantly he knows the secret of how to transform care. In fact, we can go back to the 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New Health System for the 21st Century for the six aims of health care improvement: safe, effective, patient centered, timely, efficient and equitable. Berwick was on that IOM committee and expressed concern last week with the progress we have made in meeting those goals over 12 years.
Health information technology (IT) has been touted as a way to promote safety, efficiency, quality and patient-centered care. But these benefits have yet to be realized because there has not been large scale adoption of electronic medical records (EMR) and enabling technology to achieve these goals.
A Doctor and Mother of a Premature Baby Helps Test a Mobile App for Parents of Special-Needs Infants
Nwando Eze, MD, MPH, is a neonatal fellow and mother of two practicing in Orange, California. When she was a pediatric resident, she helped test Estrellita, a smartphone app designed to support parents of infants with special health needs. Estrellita is supported by the Robert Wood Johnson Foundation (RWJF).
I smile as I note the increase in weight Ozuli has had in the last month. Having spent two-and-a-half months with Ozuli in the neonatal intensive care unit (NICU), I learned quickly that weight gain with minimal to no other problems was as close to an ideal situation as any parent could ask for in the NICU.
Ozuli was born two months early at 29 weeks unexpectedly. I was in my second year of pediatric residency and had a three-year-old already and had no problems with my previous pregnancy. So it was quite a surprise when at 29 weeks I began contracting intermittently and the contractions didn’t stop until Ozuli was born. I was put to sleep for the delivery and so did not get to see her until the next day, which just happened to fall on Mother’s Day. That day was the beginning of our two-month journey in the NICU—a journey I found to be the scariest and yet most blessed time in my life.
A few weeks before we were discharged, I agreed to enroll in a study testing a mobile health application that allowed parents of preterm infants to record ongoing health-related information about their infants. I was given a smartphone with the app in which I was to record events like daily diaper counts, daily weights, how fussy Ozuli was that day, my own daily moods, doctor’s appointment times, and follow-up visits.
Aneesah Gilbert participated in the "Change My Steps Challenge,” organized by Robert Wood Johnson Foundation Clinical Scholar Chileshe Nkonde-Price, MD, to address the fact that heart disease rates are increasing among Black women.
At age 26, I came to the realization that I wasn’t getting any younger. With this being so obvious, you’re probably sarcastically wondering: How did she figure that out? Well, I will tell you the story. One winter morning I awakened to my left arm so numb I thought it was not my own. My arm was numb because I’d slept on it all night (I had slept this way from birth up until this point).
I visited my doctor and discussed this tragedy, he laughed as he does normally to all my hypochondriac symptoms. After he had a good chuckle he told me that because of my weight (all 210 lbs. of me), the blood flow was being cut off in my arm and caused it to go numb. He then told me that my weight could cause a number of issues I did not want to experience at 26 years of age. I went home, grabbed my computer, typed in the search bar ‘DIET’ and began my stretch of unsuccessful attempts at losing weight. I came up with this personal fact: There is no diet or exercise that will work for me if I am not willing to work for it.
Kathleen Hickey, EdD, FNP-BC, ANP-BC, FAAN, is a nurse practitioner in cardiac electrophysiology, an assistant professor at the Columbia University School of Nursing, and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. Hickey is president of the International Society of Nurses in Genetics.
As a cardiovascular nurse practitioner, there have been many instances when a patient has reported an intermittent and sporadic racing of the heart, chest pressure or other vague symptom. If I had only an ECG (electrocardiogram) when that was happening, I thought to myself on many occasions.
But as most practitioners know, in the real world such episodes rarely occur while the patient is right in front of them. Rather, symptoms occur when the patient is at home, at work, has just left the provider’s office, or is on vacation!
The widespread use of smart phones has resulted in a plethora of gadgets, gizmos, and associated health care applications—but one I can’t live without is the AliveCor heart recorder and application that is now compatible with the iPhone.
Timothy Landers, RN, CNP, PhD, is an assistant professor at The Ohio State University and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
The Great Challenges Program is an ongoing effort by the TEDMED community to provide innovative, interdisciplinary perspectives on the most complex and challenging issues in health care. A year-long dialogue facilitated through social media tools and panels of experts continued at the annual gathering of TEDMED 2013.
One of the themes of TEDMED 2013 was the creative and thoughtful use of big data and small data to improve health and health care.
Small data includes individual level information specific to an individual or circumstance. In small data, “n=ME.” A vast amount of individual level information is now routinely collected. However, a large volume of data is not required for small data to be useful—in the words of one TEDMED speaker, it’s not the volume of the data, but the complexity of existing data. Data must be available and accessible in order to be useful as well.
Big data refers to patterns of data and information available at the population level. The goal of big data is to use information and take a “macroscopic” view of health. It includes the ability to recognize patterns that are not obvious or readily apparent. Big data analysis permits us to go from pieces of data to collective wisdom, a theme of TEDMED 2013.
Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.
"We suggest that nurses should embrace rather than fear these innovations."
This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases. The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.
Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.
You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.
Tom Delbanco, MD, MACP, is Koplow-Tullis Professor of Medicine at Harvard Medical School, Beth Israel Deaconess Medical Center. He is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program.
In a recent blog post, Anjali Gopalan, MD, a Robert Wood Johnson Foundation Clinical Scholar, weighed the pros and cons of OpenNotes—an effort to share clinicians’ notes with patients that is a stimulating collaboration among a large group of investigators, practitioners and patients in Boston; Danville, Pennsylvania; and Seattle.
Dr. Gopalan made a number of insightful observations that I’d like to comment on, but I need first to correct a fundamental misperception: OpenNotes is decidedly not a software program!!!
OpenNotes is an effort to convince patients, families, and clinicians to share openly any and, most often, all material that pertains to a patient’s care. The goal of such action is to improve communication between clinicians and patients, and to help patients engage more actively in managing their health and health care.
OpenNotes doesn’t depend on electronic health records or other software. Purely and simply, we are suggesting to patients that they routinely ask for a copy of their providers’ notes (to which they are legally entitled through HIPAA). And we are suggesting to clinicians that they routinely invite their patients to read them. Pull down the invisible firewall that we clinicians have long established, and the patient (and others whom he or she wishes to involve) can view the thinking that leads us to conclusions and recommendations.
To be sure, patient portals can facilitate sharing information with patients, and their future potential is enormous. But unblinding the story, the warp and woof of an individual’s experience that’s documented in clinicians’ notes, can also be done by low-tech means such as providing print copies of the notes at the end of a visit or later by mail.